LA County Paramedic Accreditation Advanced Prep:
Master Clinical Protocols & EMS Operations Practice
Questions and correct answers
Subject: LA County EMS Clinical Guidelines, Protocols, and Operations
Question 1: A 45-year-old male is found in a collapsed trench with soil coverage up to his waist
for approximately 5 hours. Upon extrication, the patient is conscious but exhibits signs of
profound muscle rigidity and dark-colored urine. Given the risk of reperfusion injury, which of
the following prophylactic interventions is most critical prior to extrication?
A) Administration of IV Furosemide to ensure adequate renal output.
B) Aggressive hydration with Normal Saline boluses to facilitate renal clearance.
C) Immediate administration of Potassium Chloride to counteract hypokalemic shifts.
D) Application of a wide tourniquet to the proximal thigh to prevent systemic toxin release.
Correct Answer: B) Aggressive hydration with Normal Saline boluses to facilitate renal
clearance.
Explanation: The patient is exhibiting classic signs of Crush Syndrome, a reperfusion injury
caused by rhabdomyolysis following prolonged compression (>4 hours). Reperfusion releases
myoglobin and potassium into the systemic circulation, leading to acute renal failure and lethal
dysrhythmias. Aggressive fluid resuscitation is the primary intervention to maintain high urinary
flow and flush myoglobin through the kidneys. Furosemide is not indicated in the prehospital
setting for this. Potassium Chloride is strictly contraindicated, as the patient is likely
hyperkalemic. Tourniquets are used for hemorrhage control, not for crush syndrome.
Question 2: Regarding the LA County "Most Accessible Receiving" (MAR) facility policy,
which of the following scenarios permits a bypass of the closest facility?
A) The patient requests transport to a hospital where they have a primary care physician.
B) The patient has an isolated orthopedic injury, and the closest facility is currently on "internal
disaster" diversion.
C) The base hospital physician directs the unit to a more distant facility to accommodate specific
clinical needs.
D) The ambulance crew determines that the traffic density will likely increase transport time by
more than 15 minutes.
,Correct Answer: C) The base hospital physician directs the unit to a more distant facility to
accommodate specific clinical needs.
Explanation: Under LA County guidelines, the base hospital physician has the ultimate authority
regarding patient destination. While "internal disaster" is a valid reason for diversion, BLS units
must transport to the MAR regardless of status unless it is an internal disaster; however, ALS
units/base direction supersede standard routing to ensure appropriate clinical care. Patient
preference or crew convenience (traffic/travel time) does not override established destination
policies unless approved by base.
Question 3: An 8-year-old patient experiences a brief episode of cyanosis while choking on a
small plastic object. The obstruction is successfully cleared by the patient's parents prior to your
arrival. According to LA County protocols, where must this patient be transported?
A) The Most Accessible Receiving (MAR) facility.
B) The nearest Pediatric Medical Center (PMC).
C) The nearest Emergency Department Approved for Pediatrics (EDAP).
D) The patient may be released to the parents with a signed refusal of transport.
Correct Answer: B) The nearest Pediatric Medical Center (PMC).
Explanation: Per LA County protocols, pediatric patients who have suffered a significant
respiratory event (choking with a brief period of cyanosis) require specialized pediatric care and
observation, necessitating transport to a Pediatric Medical Center (PMC), not merely an EDAP
or general MAR.
Question 4: You are treating a patient who has achieved ROSC following a witnessed cardiac
arrest. The patient is now hemodynamically stable but remains unconscious. According to
current LA County guidelines, which of the following is the most appropriate next step?
A) Perform an immediate 12-lead ECG.
B) Transport to the nearest Urgent Care facility.
C) Administer a prophylactic dose of antiarrhythmic medication.
D) Hyperventilate the patient to ensure rapid clearance of CO2.
Correct Answer: A) Perform an immediate 12-lead ECG.
Explanation: Achieving ROSC is a critical juncture. The immediate priority after ensuring
hemodynamic stability is to perform a 12-lead ECG to screen for STEMI or other cardiac
,pathologies that might necessitate specialized destination routing (e.g., to an SRC - STEMI
Receiving Center).
Question 5: Which of the following best describes the mandate regarding the reporting of
suspected abuse in LA County?
A) Paramedics must report all cases of suspected drug abuse.
B) Reporting is required only if physical evidence of injury is documented.
C) Mandated reporting applies to suspected child, elder, and dependent adult abuse.
D) Reporting is only required if the victim explicitly requests the paramedic to notify authorities.
Correct Answer: C) Mandated reporting applies to suspected child, elder, and dependent
adult abuse.
Explanation: Paramedics are mandated reporters under California law. This includes
reasonable suspicion of child, elder, and dependent adult abuse/neglect. Drug abuse, by itself, is
not a reportable offense under these specific mandates.
Question 6: A 22-year-old female victim of a sexual assault is being transported. She is calm
and coherent. What is the most appropriate handling of this patient?
A) Transport to the nearest hospital for immediate physical examination.
B) Release the patient to law enforcement for transport to a SART (Sexual Assault Response
Team) center.
C) Obtain a detailed statement and physical evidence, then transport to the nearest MAR.
D) Contact the base hospital for permission to bypass the closest hospital to go directly to a
SART facility.
Correct Answer: B) Release the patient to law enforcement for transport to a SART (Sexual
Assault Response Team) center.
Explanation: LA County protocol allows for the release of sexual assault patients to law
enforcement for direct transport to a SART center, provided the patient is stable and has been
appropriately assessed by the paramedic.
Question 7: You are performing a needle thoracostomy on a patient with tension pneumothorax.
What is the correct anatomical landmark in LA County?
A) The 2nd intercostal space at the midclavicular line.
, B) The 4th intercostal space at the anterior axillary line.
C) The 2nd intercostal space at the mid-axillary line.
D) The 5th intercostal space at the mid-axillary line.
Correct Answer: A) The 2nd intercostal space at the midclavicular line.
Explanation: LA County protocol specifies the 2nd intercostal space at the midclavicular line,
above the third rib, for needle thoracostomy.
Question 8: When assessing a patient for a potential stroke using the mLAPSS, which finding is
most critical to rule out before considering the stroke protocol?
A) The patient's blood pressure is above 200/100 mmHg.
B) The patient is experiencing hypoglycemia (BGL < 60 mg/dL).
C) The patient has a history of atrial fibrillation.
D) The patient is over the age of 65.
Correct Answer: B) The patient is experiencing hypoglycemia (BGL < 60 mg/dL).
Explanation: Hypoglycemia (a "stroke mimic") can present with neurological deficits identical
to an ischemic stroke. It is mandatory to rule out hypoglycemia before characterizing the patient
as a "stroke" candidate in the prehospital setting.
Question 9: A patient is found in cardiac arrest. Under what circumstance is it appropriate to
transport a patient with ongoing medical cardiac arrest?
A) If the family demands transport to a specific hospital.
B) If ROSC is not achieved after 20 minutes of on-scene resuscitation.
C) Only if the patient has a reversible cause that requires hospital intervention (e.g., severe
hypothermia).
D) Medical cardiac arrest patients should never be transported with ongoing CPR.
Correct Answer: C) Only if the patient has a reversible cause that requires hospital
intervention (e.g., severe hypothermia).
Explanation: LA County guidelines emphasize on-scene resuscitation for medical cardiac arrest.
Transporting a patient with ongoing CPR is generally contraindicated unless there are specific,
documented indications for reversible causes that cannot be managed in the field.
Master Clinical Protocols & EMS Operations Practice
Questions and correct answers
Subject: LA County EMS Clinical Guidelines, Protocols, and Operations
Question 1: A 45-year-old male is found in a collapsed trench with soil coverage up to his waist
for approximately 5 hours. Upon extrication, the patient is conscious but exhibits signs of
profound muscle rigidity and dark-colored urine. Given the risk of reperfusion injury, which of
the following prophylactic interventions is most critical prior to extrication?
A) Administration of IV Furosemide to ensure adequate renal output.
B) Aggressive hydration with Normal Saline boluses to facilitate renal clearance.
C) Immediate administration of Potassium Chloride to counteract hypokalemic shifts.
D) Application of a wide tourniquet to the proximal thigh to prevent systemic toxin release.
Correct Answer: B) Aggressive hydration with Normal Saline boluses to facilitate renal
clearance.
Explanation: The patient is exhibiting classic signs of Crush Syndrome, a reperfusion injury
caused by rhabdomyolysis following prolonged compression (>4 hours). Reperfusion releases
myoglobin and potassium into the systemic circulation, leading to acute renal failure and lethal
dysrhythmias. Aggressive fluid resuscitation is the primary intervention to maintain high urinary
flow and flush myoglobin through the kidneys. Furosemide is not indicated in the prehospital
setting for this. Potassium Chloride is strictly contraindicated, as the patient is likely
hyperkalemic. Tourniquets are used for hemorrhage control, not for crush syndrome.
Question 2: Regarding the LA County "Most Accessible Receiving" (MAR) facility policy,
which of the following scenarios permits a bypass of the closest facility?
A) The patient requests transport to a hospital where they have a primary care physician.
B) The patient has an isolated orthopedic injury, and the closest facility is currently on "internal
disaster" diversion.
C) The base hospital physician directs the unit to a more distant facility to accommodate specific
clinical needs.
D) The ambulance crew determines that the traffic density will likely increase transport time by
more than 15 minutes.
,Correct Answer: C) The base hospital physician directs the unit to a more distant facility to
accommodate specific clinical needs.
Explanation: Under LA County guidelines, the base hospital physician has the ultimate authority
regarding patient destination. While "internal disaster" is a valid reason for diversion, BLS units
must transport to the MAR regardless of status unless it is an internal disaster; however, ALS
units/base direction supersede standard routing to ensure appropriate clinical care. Patient
preference or crew convenience (traffic/travel time) does not override established destination
policies unless approved by base.
Question 3: An 8-year-old patient experiences a brief episode of cyanosis while choking on a
small plastic object. The obstruction is successfully cleared by the patient's parents prior to your
arrival. According to LA County protocols, where must this patient be transported?
A) The Most Accessible Receiving (MAR) facility.
B) The nearest Pediatric Medical Center (PMC).
C) The nearest Emergency Department Approved for Pediatrics (EDAP).
D) The patient may be released to the parents with a signed refusal of transport.
Correct Answer: B) The nearest Pediatric Medical Center (PMC).
Explanation: Per LA County protocols, pediatric patients who have suffered a significant
respiratory event (choking with a brief period of cyanosis) require specialized pediatric care and
observation, necessitating transport to a Pediatric Medical Center (PMC), not merely an EDAP
or general MAR.
Question 4: You are treating a patient who has achieved ROSC following a witnessed cardiac
arrest. The patient is now hemodynamically stable but remains unconscious. According to
current LA County guidelines, which of the following is the most appropriate next step?
A) Perform an immediate 12-lead ECG.
B) Transport to the nearest Urgent Care facility.
C) Administer a prophylactic dose of antiarrhythmic medication.
D) Hyperventilate the patient to ensure rapid clearance of CO2.
Correct Answer: A) Perform an immediate 12-lead ECG.
Explanation: Achieving ROSC is a critical juncture. The immediate priority after ensuring
hemodynamic stability is to perform a 12-lead ECG to screen for STEMI or other cardiac
,pathologies that might necessitate specialized destination routing (e.g., to an SRC - STEMI
Receiving Center).
Question 5: Which of the following best describes the mandate regarding the reporting of
suspected abuse in LA County?
A) Paramedics must report all cases of suspected drug abuse.
B) Reporting is required only if physical evidence of injury is documented.
C) Mandated reporting applies to suspected child, elder, and dependent adult abuse.
D) Reporting is only required if the victim explicitly requests the paramedic to notify authorities.
Correct Answer: C) Mandated reporting applies to suspected child, elder, and dependent
adult abuse.
Explanation: Paramedics are mandated reporters under California law. This includes
reasonable suspicion of child, elder, and dependent adult abuse/neglect. Drug abuse, by itself, is
not a reportable offense under these specific mandates.
Question 6: A 22-year-old female victim of a sexual assault is being transported. She is calm
and coherent. What is the most appropriate handling of this patient?
A) Transport to the nearest hospital for immediate physical examination.
B) Release the patient to law enforcement for transport to a SART (Sexual Assault Response
Team) center.
C) Obtain a detailed statement and physical evidence, then transport to the nearest MAR.
D) Contact the base hospital for permission to bypass the closest hospital to go directly to a
SART facility.
Correct Answer: B) Release the patient to law enforcement for transport to a SART (Sexual
Assault Response Team) center.
Explanation: LA County protocol allows for the release of sexual assault patients to law
enforcement for direct transport to a SART center, provided the patient is stable and has been
appropriately assessed by the paramedic.
Question 7: You are performing a needle thoracostomy on a patient with tension pneumothorax.
What is the correct anatomical landmark in LA County?
A) The 2nd intercostal space at the midclavicular line.
, B) The 4th intercostal space at the anterior axillary line.
C) The 2nd intercostal space at the mid-axillary line.
D) The 5th intercostal space at the mid-axillary line.
Correct Answer: A) The 2nd intercostal space at the midclavicular line.
Explanation: LA County protocol specifies the 2nd intercostal space at the midclavicular line,
above the third rib, for needle thoracostomy.
Question 8: When assessing a patient for a potential stroke using the mLAPSS, which finding is
most critical to rule out before considering the stroke protocol?
A) The patient's blood pressure is above 200/100 mmHg.
B) The patient is experiencing hypoglycemia (BGL < 60 mg/dL).
C) The patient has a history of atrial fibrillation.
D) The patient is over the age of 65.
Correct Answer: B) The patient is experiencing hypoglycemia (BGL < 60 mg/dL).
Explanation: Hypoglycemia (a "stroke mimic") can present with neurological deficits identical
to an ischemic stroke. It is mandatory to rule out hypoglycemia before characterizing the patient
as a "stroke" candidate in the prehospital setting.
Question 9: A patient is found in cardiac arrest. Under what circumstance is it appropriate to
transport a patient with ongoing medical cardiac arrest?
A) If the family demands transport to a specific hospital.
B) If ROSC is not achieved after 20 minutes of on-scene resuscitation.
C) Only if the patient has a reversible cause that requires hospital intervention (e.g., severe
hypothermia).
D) Medical cardiac arrest patients should never be transported with ongoing CPR.
Correct Answer: C) Only if the patient has a reversible cause that requires hospital
intervention (e.g., severe hypothermia).
Explanation: LA County guidelines emphasize on-scene resuscitation for medical cardiac arrest.
Transporting a patient with ongoing CPR is generally contraindicated unless there are specific,
documented indications for reversible causes that cannot be managed in the field.
